The White House’s heroin response strategy: bringing together public health and public safety

On Aug. 17, the White House Office of National Drug Control Policy (ONDCP) announced a new initiative to address the growth in heroin use in the U.S. The Heroin Response Strategy is intended to address heroin use and overdose by increasing the role of public health officials in government response efforts and by improving communications between public health and public safety officers. The initiative marks a significant departure from past efforts of the ONDCP that have focused much more exclusively on a law enforcement response to drug use. If the program is to successfully integrate public health and public safety responses to heroin use it will need to receive adequate funding and buy-in from law enforcement officials.

The Heroin Response Strategy will be funded with $2.5 million from the ONDCP. This funding will go to five High Intensity Drug Trafficking Areas (HIDTAs) across 15 states in the New England, mid-Atlantic and Appalachia regions. The HIDTA program, which Congress established in 1988, was intended to address high-level drug trafficking, but has gotten bogged down in the pursuit of minor drug offenses. The Heroin Response Strategy may alter that trajectory somewhat by requiring each of the five HIDTAs involved in the program to select one public health and one public safety coordinator. Public health coordinators will share information on overdose trends in the area and will alert public health officials when an especially dangerous batch of heroin is making its way around the region. This information is intended to facilitate overdose prevention response in the affected areas, such as through greater distribution of naloxone, a drug that reverses the effects of overdose. Funding is also provided for educating local law enforcement and other first responders on how to respond to overdoses and administer naloxone. Currently, 26 states have laws allowing for the distribution of naloxone by first responders to prevent overdose deaths.

The Heroin Response Strategy is being touted by the ONDCP as evidence of the federal government’s commitment to public health strategies for combatting heroin use. According to ONDCP Director Michael Botticelli, “The new Heroin Response Strategy demonstrates a strong commitment to address the heroin and prescription opioid epidemic as both a public health and a public safety issue.” White House officials view the program as an inclusive strategy that brings together public health and public safety, related fields that have taken divergent paths in the War on Drugs. Information sharing potentially can be quite effective by pinpointing sources of adulterated batches of heroin and hot spots for drug overdoses and passing this information along to law enforcement, which can then make targeted arrests and prepare for overdose calls. Because law enforcement — and the public — generally do not learn of public health data until months after it is collected, the inclusive approach of the initiative has the potential to bring this data to law enforcement in real time and allow them to act on it in a way that emphasizes overdose prevention and disruption of the heroin supply, rather than punishment of users.

Although the Heroin Response Initiative emphasizes the use of information sharing so that law enforcement can pursue high-level heroin traffickers, a concern among drug reform advocates is that HIDTA involvement will continue the law enforcement focus on low-level drug offenses. While senior White House officials emphasize the importance of a dual public health and safety response to current heroin use trends, it is essential that law enforcement agencies involved in the HIDTA initiative buy into the public health focus of the approach. For a field whose dominant tactic in the fight against drug use has been to arrest and punish, this may be a challenge.

Overall, the Heroin Response Strategy is an important advance in the federal government’s approach to drug use that has for too long focused on arrest and incarceration as the dominant strategy. Drug reform advocates may be correct in their assertion that the initiative still focuses too heavily on law enforcement tactics and, if the HIDTA budget allocation is any indication, public safety continues to be the favored approach to drug use. But it is important to remember that change comes cautiously, if slowly, to the federal government, and for an agency whose culture is deeply entrenched in the War on Drugs model of punishment, a program that brings public health into the fray and emphasizes overdose prevention really is a big and important change. It remains to be seen whether the program will receive the funding and bureaucratic buy-in needed for it to be successful.

Katharine A. Neill, Ph.D., is the Alfred C. Glassell, III Postdoctoral Fellow in Drug Policy at the Baker Institute. Her current research focuses on state sentencing policies for drug offenders and the legalization of medical and recreational marijuana. Neill’s other research interests include criminal justice policy, the private prison industry and the use of public-private partnerships to deliver public services.